Men's Health

Count Hairs to Learn Potential for Baldness

Want to know how much hair you are losing? Start counting - the hairs on your comb, not on your head.

Researchers say in the Archives of Dermatology that a so-called "60-second hair count" is a simple and reliable away to get a grip on whether you are balding and, if so, how fast.

The procedure, which can be carried out in the convenience of your own home, may reassure the adult male - or not.

"Hair loss is fraught with emotions," says Dr. Jeffrey Miller, senior author of the study. "Here is a hair count that allows the person to get a handle as to what's going on with their hair.

"With something like the 60-second hair count, you can participate and monitor in an objective fashion what's going on with your hair, says Dr. Miller, who is at Penn State College of Medicine.

Normal Hair Loss: 10 Strands a Day

Dr. Doris Day, at Lenox Hill Hospital in New York City, adds, "The reality is that hair loss is incredibly common among men and women. Fifty percent of both genders will have hair loss by the age of 50. That's a big number.

"It affects how you're perceived, your ability to date, and climb that corporate ladder," she adds.

Both the media and dermatology experts are fond of proclaiming that shedding 100 hairs a day is normal.

That is probably too high, Dr. Miller says. But there is little scientific evidence for that number, which is based on the assumption that the average scalp holds 100,000 hairs, 10 percent of which are at any one time in the telogen, or resting, phase.

Not only do experts not know how much hair loss is normal, they also do not have any standardized way of assessing the amount of hair lost on an average day.

"We keep saying the same things over and over, that it's normal to lose 100 hairs a day," says Dr. Day. "The question is, how normal is it and what is normal in terms of hair loss."

The "wash test" involves washing one's hair over a sink five days after the last shampoo, a waiting period some might find objectionable.

A more up-to-date method is the 60-second hair count, used in this study.

Sixty healthy men ages 20 to 60 without evidence of baldness participated. All were Caucasian and all but one had straight hair.

The authors excluded, for the most part, men with curly hair and long hair "because of the difficulty of running a comb through the hair, which would lead to increased numbers of broken" hairs, which were not counted.

The men washed their hair three mornings in a row with Neutrogena T/Sal® shampoo. On the fourth day, they were issued identical combs and instructed to comb their hair forward over a towel or pillowcase of contrasting color.

They were then asked to count the hairs that had dropped out. This comb-and-count procedure was repeated on the next two days and the number of hairs was validated under a microscope.

After six months, the participants repeated the full procedure.

Based on these results, the authors concluded that losing 10 hairs is "normal."

In younger men (aged 20 to 40), the shedding range was zero to 78 hairs with an average of 10.2 hairs. In the older men, the range was zero to 43 hairs with an average of 10.3 hairs.

Take the Home Test to Learn More

To perform the count, comb your hair for 60 seconds over a pillow or sheet of contrasting color before shampooing.

Pull the comb from the back top of the scalp forward to the front of the scalp for 60 seconds. "That 60 seconds allows you to dislodge any of the resting hairs that are supposed to be shed," explains Dr. Miller.

Repeat the procedure before three consecutive shampooing sessions, always using the same comb. Count and record the number of hairs in the comb and on the pillow or sheet.

Repeat the procedure every month and discuss results with your dermatologist.

The authors say they will be releasing comparable data for women in the near future.

When to start panicking over hair loss? Dr. Miller counsels men who lose more than 50 hairs a day (as counted in the 60-second period) to check with their physician.

"The hair acts like a window to the inside of the body," he says. "If there's something going on inside the body that is not right, for example, low thyroid output or low iron, your hair can react by shedding more.

"So if you notice that you're shedding a lot of hair on the 60-second hair count, it would be worthwhile to be evaluated by physician to rule out underlying medical causes," notes Dr. Miller.

Sudden changes in the amount of hair you lose should also be evaluated, he says.

The study was funded by Merck & Co. and Dr. Miller has received consulting fees from the drug company Pfizer Inc.

Always consult your physician for more information.

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August 2008

Facts about Hair Loss

Hair loss is believed to be primarily caused by one or a combination of these factors: aging, change in hormones, illness, family history of baldness, burns, or trauma.

However, hair loss is not caused by poor circulation to the scalp, vitamin deficiencies, dandruff, excessive hat-wearing, or a gene passed on from an individual's maternal grandfather.

Generally, the earlier hair loss begins, the more severe the baldness will become.

The interest in hair replacement has significantly increased over the past 10 years. Two out of every three men and one in five women suffer from hair loss.

For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery cannot help those who suffer from total baldness.

Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including the following:

hair transplantation
During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.

tissue expansion
In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.

flap surgery
Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.

scalp reduction
Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Medications to address balding include finasteride (Propecia®). Propecia, was approved by the US Food and Drug Administration (FDA) in December 1997, as a treatment for male pattern baldness. It is the first drug available in pill form for the treatment of baldness.

In men with mild to moderate hair loss, clinical trials showed that 83 percent of the male patients had kept their hair or grown more after one year of treatment. Propecia works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydrotestosterone in a man's body.

The enzyme converts testosterone to DHT (dihydrotestosterone). It is believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp.

A second medication, called minoxidil (Rogaine®), has been available since 1988 for the treatment of hair loss.

Minoxidil is topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness.